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Background: The application of transthoracic contrast-enhanced ultrasound (CEUS) to the study of peripheral lung lesions is still a topic of debate. The main objective of this review was to evaluate the diagnostic accuracy of CEUS in the diagnosis of malignant subpleural pulmonary consolidations and, therefore, differentiate them from benign ones. Methods: Papers published before December 2023 were detected through a search of PubMed, Cochrane library, and Embase. The pooled specificity and sensitivity, summary receiver operating characteristic (SROC) curve and diagnostic odds ratio (DOR) were used. Results: CEUS is characterized by a pooled sensitivity of 0.95 (95% CI: 0.93–0.97) and a pooled specificity of 0.93 (95% CI: 0.90–0.95) in differentiating benign and malignant subpleural lung diseases; the AUC of SROC was 0.97. Homogeneous CE was characterized by a pooled sensitivity of 0.43 (95% CI: 0.40–0.45) and the pooled specificity of 0.49 (95% CI: 0.46–0.52). Non-homogeneous CE displayed a pooled sensitivity of 0.57 (95% CI: 0.55–0.60) and a pooled specificity of 0.51 (95% CI: 0.48–0.54). The lack of CE displayed a pooled sensitivity of 0.01 (95% CI: 0.00–0.06) and a pooled specificity of 0.76 (95% CI: 0.64–0.85). Marked CE displayed a pooled sensitivity of 0.41 (95% CI: 0.37–0.44) and a pooled specificity of 0.54 (95% CI: 0.50–0.58). Non-marked CE displayed a pooled sensitivity of 0.59 (95% CI: 0.56–0.63) and a pooled specificity of 0.46 (95% CI: 0.42–0.50). The early AT displayed a pooled sensitivity of 0.04 (95% CI: 0.02–0.08) and a pooled specificity of 0.83 (95% CI: 0.77–0.87). The early wash out displayed a pooled sensitivity of 0.61 (95% CI: 0.48–0.72) and a pooled specificity of 0.98 (95% CI: 0.92–1.00). The delayed wash out displayed a pooled sensitivity of 0.15 (95% CI: 0.10–0.20) and a pooled specificity of 0.69 (95% CI: 0.62–0.75). Conclusions: CEUS is characterized by excellent diagnostic accuracy for the diagnosis of the malignancy of subpleural lung lesions. By separately analyzing the CEUS findings, the diagnostic accuracy values are considerably lower and not significant in some cases. The simultaneous evaluation of multiple CEUS features allows us to reach an excellent diagnostic accuracy. Non-homogeneous CE with early wash out are the most indicative features of malignancy of a lung lesion. [ABSTRACT FROM AUTHOR]

The application of thoracic ultrasound examination has not long been developed because ultrasound's interaction with the lung does not generate an anatomical image but an artifactual one. Subsequently, the evaluation of pulmonary artifacts and their correlation to specific diseases allowed the development of ultrasound semantics. Currently, pneumonia still represents one of the main causes of hospitalization and mortality. Several studies in the literature have demonstrated the ultrasound features of pneumonia. Although ultrasound cannot be considered the diagnostic gold standard for the study of all lung diseases, it has experienced an extraordinary development and growth of interest due to the SARS-CoV-2 pandemic. This review aims to provide essential information on the application of lung ultrasound to the study of infectious pneumonia and to discuss the differential diagnosis. [ABSTRACT FROM AUTHOR]